Hospital Admission Surveillance for CPE
Hospital Admission Surveillance for CPE
During the 24-month study period, 262 patients, comprising 308 total admissions, received care at the LTACH. Of 308 admissions, 227 were from the UVA Medical Center, and 81 were from 20 referral hospitals within the surrounding area.
Twenty patients had positive CPE clinical or perirectal surveillance cultures during their LTACH admission (7.63% of patients, 6.49% of admissions). All CPE isolates harbored the blaKPC gene. Of these 20 patients, 6 had a prior history of CPE colonization or infection and had positive CPE perirectal cultures on admission. Seven of the 20 patients had no known history of CPE infection or colonization and were negative on admission screen but had a positive CPE perirectal culture later during the hospitalization. The median time from admission to positive CPE screen was 14 days (range, 5–71 days). One patient was inadvertently not screened on admission but was positive 1 week later; this patient was excluded from analysis. The remaining 6 patients had no known history of CPE colonization or infection but were found to have positive CPE screening cultures on admission. Interestingly, 12 patients with a prior history of CPE colonization or infection had negative perirectal cultures on admission.
Of the 6 patients with newly identified CPE colonization on admission, 1 had a concurrent CPE infection, a urinary tract infection due to KPC-producing Enterobacter cloacae. The remaining 5 patients were found to be colonized on the basis of screening culture alone—3 with K. pneumoniae and 2 with E. cloacae. The mean duration of hospitalization for these patients prior to LTACH admission was 33 days (range, 8–103 days). All patients had an invasive medical device in place at the time of admission; most (83%) had wounds requiring directed care.
Of the 6 patients with newly detected CPE, 4 were admitted from 4 separate regional hospitals, and 2 were admitted from the affiliated acute care hospital. The incidence of previously unrecognized CPE colonization was 1.95% (6/308) of admissions and 2.29% (6/262) of patients. The detection rate among admissions from the affiliated acute care hospital, which has an active CPE surveillance protocol in place, was 0.88% (2/227), while the rate among admissions from regional hospitals was significantly higher at 4.94% (4/81; P = .024). Five of 21 originating institutions (23.8%) transferred patients to the LTACH with unrecognized CPE colonization.
Results
During the 24-month study period, 262 patients, comprising 308 total admissions, received care at the LTACH. Of 308 admissions, 227 were from the UVA Medical Center, and 81 were from 20 referral hospitals within the surrounding area.
Twenty patients had positive CPE clinical or perirectal surveillance cultures during their LTACH admission (7.63% of patients, 6.49% of admissions). All CPE isolates harbored the blaKPC gene. Of these 20 patients, 6 had a prior history of CPE colonization or infection and had positive CPE perirectal cultures on admission. Seven of the 20 patients had no known history of CPE infection or colonization and were negative on admission screen but had a positive CPE perirectal culture later during the hospitalization. The median time from admission to positive CPE screen was 14 days (range, 5–71 days). One patient was inadvertently not screened on admission but was positive 1 week later; this patient was excluded from analysis. The remaining 6 patients had no known history of CPE colonization or infection but were found to have positive CPE screening cultures on admission. Interestingly, 12 patients with a prior history of CPE colonization or infection had negative perirectal cultures on admission.
Of the 6 patients with newly identified CPE colonization on admission, 1 had a concurrent CPE infection, a urinary tract infection due to KPC-producing Enterobacter cloacae. The remaining 5 patients were found to be colonized on the basis of screening culture alone—3 with K. pneumoniae and 2 with E. cloacae. The mean duration of hospitalization for these patients prior to LTACH admission was 33 days (range, 8–103 days). All patients had an invasive medical device in place at the time of admission; most (83%) had wounds requiring directed care.
Of the 6 patients with newly detected CPE, 4 were admitted from 4 separate regional hospitals, and 2 were admitted from the affiliated acute care hospital. The incidence of previously unrecognized CPE colonization was 1.95% (6/308) of admissions and 2.29% (6/262) of patients. The detection rate among admissions from the affiliated acute care hospital, which has an active CPE surveillance protocol in place, was 0.88% (2/227), while the rate among admissions from regional hospitals was significantly higher at 4.94% (4/81; P = .024). Five of 21 originating institutions (23.8%) transferred patients to the LTACH with unrecognized CPE colonization.